Background

The incidence of perianal fistulas in IBD varies between 10–48% for Crohn's disease (CD) and 5% for ulcerative colitis (UC), constituting a complication that affects patient quality of life and often requires urgent attention. New biological treatments and management in multidisciplinary units has improved clinical course among this complicated group of patients.

Objectives: Retrospective analysis of patients with IBD and complex perianal fistulas in follow-up in our Unit over the last 15 years.

Methods

The IBD Unit currently performs follow-up on 750 patients (CD: 350; UC: 400) whose most significant data has been collected in a database. In the first phase, patients with perianal disease were selected, however only complex fistulas were included. The type of medical treatment received, use of setons or need for drainage, index of recurrences and abscesses, number of proctectomies performed, as well as the number of patients in follow-up in the IBD Nursing Unit were evaluated.

Results

13.7% of patients with CD and 0.7% of patients with UC had complicated fistulas with no difference based on gender. 19.6% of patients remained in remission with azathioprine, with the use of biological therapies required in 80.3% of cases. During the follow-up period, methotrexate was used in 9 cases (17%), two of these in combination with biological therapy. We have used different strategies in refractory patients (hyperbaric chamber, oral or topical tacrolimus, topical treatment with 10% metronidazole, local injection of infliximab) with varying results. A high percentage of patients required surgical treatment, the majority (60%) by placement of setons and/or simple drainage (31%). A temporary colostomy was performed in 4 patients (7.8%) and radical proctectomy was performed in 3 cases (6%). 72.5% of patients required admission, primarily due to surgery, 90% of which were for a short period (48–72 hours). The majority of cases (88.24%) were controlled in the nursing clinic with dressing changes, psychosocial support and early detection of recurrences (66%).

Conclusion

Conclusions:

The percentage of patients with complicated fistula disease in our unit is similar to that seen in the majority of published studies, as are the treatments offered. Notable is the combined medical-surgical treatment strategy: biological therapy+setons.

Specialized nursing care plays an important role in the early detection and follow-up of patients with complex fistulas, as well as help and support in the loss of quality of life involved.